From time to time new clients tell me that a previous therapist was “not helpful” or “incompetent,” and I often inquire as to what “worked” and what “didn’t work” in these unfortunate therapeutic experiences. The clients’ answers are not always the same, and there-in lies the rub: Therapists personalities and approaches are not one-size-fits all.
We know that one of the largest predictors of therapeutic success is the relationship between the therapist and the client,. The client-therapist relationship is, arguably, even more important than the specific treatment modality or technique used by the therapist. So universally “good” therapists are effective at forging relationships, effective at providing clients with the type of interaction that makes them feel comfortable and connected. But, of course, each client has a different idea of what therapeutic responses elicit a “comfortable and connected” dynamic…
While one client feels a sense of accomplishment and progress when the therapist interrupts his story-telling with a suggestion or observation, another client feels judged and dejected. While one client views a therapist’s consistent support and validation as empowering and relieving, another client is annoyed that the therapist “never gives me any actual help.” While one client salivates over worksheets, “homework,” and suggested reading, another client feels overwhelmed and off-put by such tools. While one client feels a sense of ease and bonding when his therapist casually refers to stress as “difficult shit,” another client is disturbed by the lack of professionalism. And all of this is subject to change as the relationship progresses.
So in a field where one approach is not always best suited for each client’s particular experiences, needs, and personalities, I suspect that what makes a universally “good” clinician might simply be these three things:
1). Basic characteristics/interpersonal skills that contribute to any quality relationship. (mutual respect, attentive listening, common courtesy, attempts at empathy, honesty, integrity, humility, genuineness, etc.)
2). An ability and willingness to understand the needs and perspectives of the client as they pertain to the therapeutic process and any subjects that may arise. (This does not require psychic abilities or even that much experience. I believe a universally “good” therapist often simply asks for the client’s feedback on the content, style, and pace of therapy. This also, incidentally, encourages constructive, collaborative communication– necessary ingredients for a great relationship– and empowers the client to take ownership of his/her own process. No former client of a “good” therapist can say, “She talked too much” or “She didn’t hold me accountable enough,” without also acknowledging that he squandered offered opportunities to voice those concerns.)
3). An ability to offer an appropriate balance of support (validation, understanding, highlighting existing strengths, positive regard) and accountability (suggestions, challenging questions, redirection, feedback, homework). Since we are discussing the therapeutic relationship, and not the therapeutic agenda, it should be emphasized that this balance is dependent on the client and therapist’s collaboration, not on the therapist’s whim. The therapist and the client know that this support/accountability balance is appropriate when the client feels both supported and challenged for growth. (Also, as described in #2: While striking this balance requires a solid clinical knowledge, it requires no psychic abilities. I believe that a “good” therapist may check-in from time to time with, “how are you doing with that feedback? Too much? Not enough? … Oh, it made you feel more discouraged when I suggested exercise? Let’s boil that down to a smaller, more realistic goal, because the last thing I want is for you to feel overwhelmed….”)
Are there any other qualities that you think a “good” therapist should possess? I’d love to hear your opinions and experiences! Please include your input in the comments.